立体定向颅内血肿穿刺引流术与保守治疗幕上中等量脑出血疗效和安全性的Meta分析  

Meta-analysis of the efficacy and safety of stereotactic puncture and drainage of intracranial hematoma and conservative treatment of moderate supratentorial intracerebral hemorrhage

作　　者：赵云飞 滕绘 金胜昔[1] ZHAO Yunfei;TENG Hui;JIN Shengxi(Department of Neurosurgery,Tianyou Hospital Affiliated to Wuhan University of Science and Technology,Wuhan,Hubei 430061,China)

机构地区：[1]武汉科技大学附属天佑医院神经外科,湖北武汉430061

出　　处：《检验医学与临床》2024年第10期1443-1449,共7页Laboratory Medicine and Clinic

摘　　要：目的分析立体定向颅内血肿穿刺引流术与保守治疗幕上中等量(15~40 mL)自发性高血压脑出血的疗效及安全性。方法根据设定的检索策略,检索中国知网、万方、维普、中国生物医学文献服务系统、PubMed、Cochranelibrary、Embase、Web of science数据库,利用RevMan5.4软件对纳入的研究按照不同观察指标[平均住院时间、平均住院费用、血肿清除率、美国国立卫生研究院卒中量表(NIHSS)评分、术后并发症、预后评分、病死率]进行Meta分析。结果收集符合标准的12篇文献,共1264例高血压脑出血病例,其中进行立体定向手术(立体定向组)681例,保守治疗(保守治疗组)583例。两组患者在手术后消化道出血发生率比较,差异无统计学意义(OR=1.19,95%CI:0.36~3.89,P>0.05)。与保守治疗组比较,立体定向组在平均住院时间和住院费用、血肿清除率、术后NIHSS评分、术后并发症、预后评分、病死率方面更有优势,差异有统计学意义(P<0.05)。结论立体定向颅内血肿穿刺引流术是治疗中等量高血压性脑出血的一种微创手术方法,较保守治疗效果确切,并发症发生率更低,利于临床开展,更能使患者获益。Objective To analyze the efficacy and safety of stereotactic puncture and drainage of intracranial hematoma and conservative treatment of supratentorial moderate volume(15-40 mL)spontaneous hypertensive intracerebral hemorrhage.Methods According to the set search strategy,CNKI,Wanfang,VIP,China Biomedical Literature Service System,PubMed,Cochranelibrary,Embase,Web of science databases were searched.The included studies were analyzed by Meta according to different observation indexes(average hospital stay,average hospital cost,hematoma clearance rate,National Institutes of Health Stroke scale(NIHSS),postoperative complications,prognosis score and mortality).Results A total of 1264 cases in 12 clinical studies were collected,including 681 cases with stereotactic surgery(stereotactic group)and 583 cases with conservative treatment(conservative treatment group).There was no significant difference on the incidence rate of gastrointestinal bleeding between the two groups(OR=1.19,95%CI:0.36-3.89,P>0.05).Compared with those in conservative treatment group,the stereotactic group had more advantages in average hospitalization time and cost,hematoma clearance rate,postoperative NIHSS score,postoperative complications,prognosis score,mortality,the differences were statistically significant(P<0.05).Conclusion As a minimally invasive surgical method,stereotactic puncture and drainage of intracranial hematoma is more effective than conservative treatment in the treatment of moderate hypertensive intracerebral hemorrhage,and the incidence of complications is lower,which is beneficial to clinical development and benefit patients.

关 键 词：立体定向 保守治疗 中等量 高血压 脑出血 META分析 

分 类 号：R743.2[医药卫生—神经病学与精神病学]